Attempts to scam Medicaid Members popping up nationwide as unwinding commences

By National Association of Medical Directors / April 3, 2023

State Medicaid leaders address the rise of bad actors seizing to make a quick buck off of Medicaid members as state/territory Medicaid agencies begin massive outreach efforts to return to normal eligibility operations.

Compounding the already unprecedented scale and scope of the national effort to conduct eligibility checks for all 91 million Americans who have Medicaid as their health insurer, Medicaid agencies and their leaders were hit with a new challenge.

The scammers and bad actors have seized on this as a way to make a quick buck off of unsuspecting Medicaid members. In the midst of large-scale Medicaid member outreach happening in every state and territory, fraudsters are complicating efforts to get clear and actionable information in member hands.

Eligibility leaders in Wyoming were some of the first to discover fraud in their state. There, individuals were calling residents, some of whom are existing Medicaid members, and demanding they pay a fee – as much as $500 — or risk losing their health insurance. The Wyoming Medicaid agency jumped into action. They issued a press release to let the public know what messages from the state are legitimate and make it crystal clear that the state would never require payment in the renewal process. They reached out to community-based partners, like health insurance Navigators, to be on the lookout for this scam and spread the word to the individuals they serve.

NAMD elevated this issue for all 56 states and territories ensuring eligibility leaders, public information officers, and others in Medicaid agencies across the country knew about what was happening. We urged states and territories to be on the lookout in their own communities.

Not surprisingly, Medicaid leaders took this information and responded quickly. In a matter of days, many states adapted Wyoming’s messaging and began notifying their own partners and communities to be on the lookout.  Whether they have detected nefarious actors or not, many states like Arizona, have included anti-fraud language in their communications with members and on resources they provide to their members ongoing.

Given the complexity of the unwinding effort for every state and the challenges and confusion already present in this effort for Medicaid members, it is critical that accurate information be pushed out and amplified. Medicaid agencies can’t counter disinformation and fraud alone. They will need support from the myriad stakeholders who share state Medicaid’s interest in the health and wellbeing of the members they serve.

Actions Medicaid’s partners can take

National and state partners — like plans, providers, consumer advocacy groups, and others – can help Medicaid combat this fraud. Urge consumers to be alert for potential scams and make sure their address is up to date with their state or territory Medicaid program so they receive all official notices.